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1 Essential Health Benefit Benchmark Plan Coverage of Rehabilitation, Habilitation, and Autism Services This information is derived from CCIIO s supplementary materials referenced in Appendix A of the EHB final rule. All information in this chart that is not from those materials has a link, a statutory reference, or is bracketed. Many fields are paraphrased. Under the exclusions column, if it indicates none, that only means none were listed in CCIIO s materials, or the information seemed more appropriate for another column. Other rehabilitative and habilitative services are covered under many plans inpatient, SNF, and home health benefits, but for the most part, those are not referenced in this chart. In the analysis column, there is no mention of inadequate visit limits, even though many plans visit limits are quite low. 17 states benchmark plans have little or no distinction between their coverage of rehabilitative and habilitative services states benchmark plans (data isn t clear) have no coverage of habilitative services, and those states have not taken action to define coverage requirements. Alabama (default) Alaska (default) State Rehabilitation Habilitation Exclusions Definitions Analysis 30 combined visits per See rehab None None No distinction person per year of between rehab PT/SLP/OT for rehab and and hab hab combined 45 visits per year for rehab and hab combined See rehab 1) Recreational, vocational, or educational therapy, exercise, or maintenance-level programs 2) Social or cultural therapy 3) Treatment that isn't actively engaged in by the ill, injured, or impaired member None No distinction between rehab and hab Maintenance explicitly excluded

2 4) Gym or swim therapy 5) Custodial care Arizona 60 visits per year No coverage None None **No hab coverage** No specific mention of covered therapies Arkansas 30 procedures per year (depends on the type of outpatient services) Limit to 30 aggregate visits per member per contract year. All therapies combined in the limit. See definitions None Definition of Habilitative Services: Services provided in order for a person to attain and maintain a skill or function that was never learned or acquired and is due to a disabling condition. Coverage of Habilitative Services: Subject to permissible terms, conditions, exclusions and limitations, health benefit plans, when required to provide essential health benefits, shall provide coverage for physical, ABA covered under Other (Excludes Sensory Integration, LOVAAS Therapy and Music Therapy) Reasonably good hab coverage (e.g. distinct, no age limits, mentions therapies, parity, mentions maintenance) ABA covered under Other 2

3 California PT/OT/SLP See definitions Rehab: none Hab: Certain limitations on types of care givers for behavioral health treatment as described in H&S Code section [includes a variety of professionals including OT/PT/SLP and BCBAs] CA Health and Safety occupational and speech therapies, developmental services and durable medical equipment for developmental delay, developmental disability, developmental speech or language disorder, developmental coordination disorder and mixed developmental disorder. The Arkansas Insurance Department (AID) will continue to develop criteria by which AID will evaluate the EHB habilitative services coverage. At a minimum, criteria will be at parity with EHB rehabilitative services coverage. Habilitative services means medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health condition, to the maximum extent practical. These services address the skills and abilities needed for functioning in interaction Definition of hab, in part, by explicit and broad exclusions Excludes maintenance under hab Confusing use of necessity in hab definition 3

4 Colorado PT/OT/SLP 20 visits per year per therapy type Code sec (Stats 2012, ch. 854) requires that individual or small group health care service plans provide habilitative services, to the extent required under state law and as required by federal rules and regulations in section 1302(b) of the ACA. with an individual's environment. Examples of health care services that are not habilitative services include, but are not limited to, respite care, day care, recreational care, residential treatment, social services, custodial care, or education services of any kind, including, but not limited to, vocational training. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the policy. See definitions None "Habilitative services are services that help a person retain, learn, or improve skills and functioning for daily living that are offered in parity with, and in addition to, any rehabilitative services offered in Colorado's EHB benchmark plan. Parity in this context means of like type and substantially equivalent in scope, amount, and duration." Defining habilitative benefits in this manner provides habilitative benefits on par with those currently offered in Solid coverage (e.g. covers maintenance under hab, parity, distinct, no age or condition limits, explicit mention of therapy types) ASD (no mention of specific services) covered under Other 4

5 Connecticut 40 combined visits per year of PT/OT/SLP Medically necessary short term outpatient rehabilitative therapy (including those services rendered at a day program facility and in an office). No coverage Unless provided under Autism Services Rehab: Services are limited to short-term physical, occupational and speech therapy necessary to restore a function lost through or to eliminate an abnormal function that has developed due to injury or illness. Speech therapy for developmental speech delays, stuttering, lisps, and other non-injury or non-illness related speech impediments are not covered, except as provided in the Autism Services or Birth To Three Program (Early Intervention Services) provisions of Other Outpatient Services subsection C. Postoperative physical therapy for temporomandibular joint (TMJ) dysfunction surgery is covered when the TMJ surgery rehabilitation and reflects current utilization in the rehabilitative arena. Autism Services covered with no quantitative limits, but other unspecified limitations Hab not covered except for unspecified Autism Services 5

6 Delaware 30 combined visits per year of PT/OT/SLP See definitions DC OT/PT/SLP Defined in DC Code for children 21 and under is covered under this Plan. This physical therapy must be obtained during the 90- day period beginning on the date of the covered TMJ surgery and it must be Pre- Authorized by us as part of the surgical procedure. Other unspecified exclusions None Delaware will require that coverage for habilitative services be on parity with those for rehabilitative services as outlined in the state s Essential Health Benefit benchmark. Habilitative services means services, including occupational therapy, physical therapy, and speech therapy, for the treatment of a child with a congenital or genetic birth defect to enhance the child's ability to function. (D.C. Code (3)) Unless recommendation is adopted, hab benefit is pediatric only DC Exchange Work group made the following recommendations: Recommendations: i. That there be no age 6

7 restriction on eligibility for habilitative services. ii. That the National Association of Insurance Commissioner s (NAIC) definition of habilitative services be adopted, Habilitation Services - Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. iii. That coverage of applied behavior analysis (ABA) be 7

9 performed as a treatment for acne, services and supplies for smoking cessation programs and treatment of nicotine addiction, and carbon dioxide. Self-Help - Biofeedback, recreational, educational or sleep therapy or other forms of self-care or self-help training and any related diagnostic testing. Inpatient Rehabilitation - Inpatient rehabilitation in the Hospital or Hospitalbased rehabilitation facility, when the Participant is medically stable and does not require skilled nursing care or the constant availability of a Physician or: the treatment is for maintenance therapy; or the Participant has no restorative potential; or the 9

10 treatment is for congenital learning or neurological disability/disorder; or the treatment is for communication training, educational training or vocational training. Mental/Behavioral Outpatient: Educational services and treatment of behavioral disorders, together with services for remedial education including evaluation or treatment of learning disabilities, minimal brain dysfunction, developmental and learning disorders, behavioral training, and cognitive rehabilitation. This includes services, treatment or educational testing and training related to behavioral (conduct) problems, Developmental Delay (when it is less than two standard 10

11 deviations from the norm as defined by standardized, validated developmental screening tests, such as the Denver Developmental Screening Test), including but not limited to services for conditions related to autistic disease of childhood (except to the same extent that the Contract provides for neurological disorders), hyperkinetic syndromes, including attention deficit disorder and attention deficit hyperactivity disorder, learning disabilities, behavioral problems, and mental retardation. Special education, including lessons in sign language to instruct a Participant, whose ability to speak has been lost or impaired, to function without that ability, is not covered. Self-Help - 11

12 biofeedback, recreational, educational or sleep therapy or other forms of self-care or self-help training and any related diagnostic testing. Hawaii PT/OT/SLP No coverage Rehab: Maintenance therapy, defined as activities that preserve present functional level and prevent regression, are not covered. Idaho (default) PT/ OT/SLP services are for the purpose of restoring certain functional losses due to disease, illness or injury PT/OT/SLP services related to developmental and rehabilitative care, with reasonable expectation that the services will produce measurable improvement in the Insured s condition in a reasonable period of time. Illinois Covered with no description See definitions and exclusions None Rehab: other unspecified exclusions None 20 visit limit is combined for all three therapies. Outpatient Rehabilitation and Habilitative services are a combined limit. Covered Services are for the purpose of restoring certain functional losses due to disease, illness or injury only and do not include maintenance services. Your benefits for Habilitative Services for persons with a **No coverage of hab** Maintenance explicitly excluded for rehab No distinction between rehab and hab Maintenance explicitly excluded Reasonable period of time requirement in hab coverage concerning Limitations on hab somewhat vague 12

13 Separate descriptions of coverage for OT/PT/SLP (see exclusions) OT: Covered when these services are rendered by a registered Occupational Therapist under the supervision of a Physician. This therapy must be furnished under a written plan established by a Physician and regularly reviewed by the therapist and Physician. The plan must be established before treatment begins and must relate to the type, frequency and duration of therapy and indicate anticipated goals and diagnosis. Congenital, Genetic, or Early Acquired Disorder are the same as your benefits for any other condition if all of the following conditions are met: 1. A Physician has diagnosed the Congenital, Genetic, or Early Acquired Disorder; and 2. Treatment is administered by a licensed speech language pathologist, Audiologist, Occupational Therapist, Physical Therapist, Physician, licensed nurse, Optometrist, licensed nutritionist, Clinical Social Worker, or Psychologist upon the referral of a Physician; and; 3. Treatment must be Medically Necessary and therapeutic and not Investigational. Coverage of ASD services under Other PT: Covered when rendered by a registered professional Physical Therapist under the supervision of a Physician. The therapy must be furnished under a written plan established by a Habilitative services for children. (a) As used in this Section, "habilitative services" means occupational therapy, physical therapy, speech therapy, and other services prescribed by the insured's treating physician pursuant to a treatment plan to 13

14 Physician and regularly reviewed by the therapist and the Physician. The plan must be established before treatment begins and must relate to the type, frequency and duration of therapy and indicate anticipated goals and diagnosis. Preventive physical therapy for Multiple Sclerosis patients is covered as mandated. SLP: Covered when these services are rendered by a licensed Speech Therapist or Speech Therapist certified by the American Speech and Hearing Association. Inpatient Speech Therapy benefits will be provided only if Speech Therapy is not the only reason for admission. Hab: Benefit available only for Congenital, enhance the ability of a child to function with a congenital, genetic, or early acquired disorder. A congenital or genetic disorder includes, but is not limited to, hereditary disorders. An early acquired disorder refers to a disorder resulting from illness, trauma, injury, or some other event or condition suffered by a child prior to that child developing functional life skills such as, but not limited to, walking, talking, or selfhelp skills. Congenital, genetic, and early acquired disorders may include, but are not limited to, autism or an autism spectrum disorder, cerebral palsy, and other disorders resulting from early childhood illness, trauma, or injury. (215 Ill. Comp. Stat. 5/356z.15(a)) (existing statutory definition not pursuant to ACA or specific to EHB) Treatment for Autism Spectrum Disorder(s) shall include the following care when prescribed, provided or ordered for an 14

15 Genetic or Early Acquired Disorders diagnoses. Habilitative Services that are solely educational in nature or otherwise paid under State or Federal law for purely educational services are excluded. individual diagnosed with an Autism Spectrum Disorder by (a) a Physician or a Psychologist who has determined that such care is medically necessary, or, (b) a certified, registered, or licensed health care professional with expertise in treating Autism Spectrum Disorder(s) and when such care is determined to be medically necessary and ordered by a Physician or a Psychologist: psychiatric care, including diagnostic services; psychological assessments and treatments; habilitative or rehabilitative treatments; therapeutic care, including behavioral Speech, Occupational and Physical Therapies that provide treatment in the following areas: a) self care and feeding, b) pragmatic, receptive and expressive language, c) cognitive functioning, d) applied behavior analysis (ABA), intervention and modification, e) motor planning and f) sensory processing. 15

17 types of similar equipment. PT: Non Covered Services include: maintenance therapy to delay or minimize muscular deterioration in patients suffering from a chronic disease or illness; repetitive exercise to improve movement, maintain strength and increase endurance (including assistance with walking for weak or unstable patients); range of motion and passive exercises that are not related to restoration of a specific loss of function, but are for maintaining a range of motion in paralyzed extremities; general exercise programs; diathermy, ultrasound and heat treatments for pulmonary conditions; diapulse; work hardening. 17

18 Iowa (default) Covered with no description, except to say it includes cardiac rehab Separate descriptions of coverage for OT/PT/SLP OT: Services to treat the upper extremities, which mean the arms from the shoulders to the finders. SLP: Rehabilitative Speech Therapy services when related to a specific illness, injury, or impairment. See definitions and exclusions Additional exclusions for cardiac rehab. Hab: Therapies rendered primarily for job training and therapy services related to general conditioning of the patient. Any habilitation not related to developmental delay is not covered. The following exclusions are specific to the therapy types, but not specific to the rehab and hab categories: Habilitative services driven by congenital disorders/ developmental delays are covered. Coverage of hab is vague Coverage of OT limited to upper extremities Occupational therapy supplies and occupational therapy provided as an inpatient in the absence of a separate medical condition that requires hospitalization. Speech therapy services not provided by a licensed or certified Speech 18

21 Louisiana (default) Inpatient or Outpatient services for OT/PT/SLP, and/or Chiropractic Services. The Member must be able to tolerate a minimum of 3 hours of active therapy per day. See rehab (and analysis) for weak or unstable patients); range of motion and passive exercises that are not related to restoration of a specific loss of function, but are for maintaining a range of motion in paralyzed extremities; general exercise programs; diathermy, ultrasound and heat treatments for pulmonary conditions; diapulse; work hardening. Other exclusions: Visual therapy; lifestyle/habit changing clinics and/or programs; recreational therapy; primarily to enhance athletic abilities; and/or Inpatient pain rehabilitation and pain control programs. An Inpatient rehabilitation Admission must be Authorized prior to the Admission and must begin within 72 hours following the discharge Autism Spectrum Disorders (ASD) Benefits include, but are not limited to the Medically Necessary assessment, evaluations, or tests performed for diagnosis, habilitative or rehabilitative care, pharmacy care, psychiatric care, psychological care, and therapeutic care. Members who have not yet reached their 17 th birthday are eligible for Applied Behavior Analysis, when Company determines it is Medically Necessary No distinction between rehab and hab (verbatim same for rehab and hab) OT/PT/SLP and/or chiro ASD services covered under Other 21

22 Maine (default) PT/OT/SLP, respiratory therapy and cardiac rehabilitation. 60 visit/year limit applies to PT/OT/SLP combined. Benefit limits are shared between rehabilitation and habilitation services. See rehab from an Inpatient Hospital Admission for the same or similar condition. Day Rehabilitation Programs for Rehabilitative Care may be Authorized in place of Inpatient stays for rehabilitation. Day Rehabilitation Programs must be Authorized prior to beginning the program and must begin within 72 hours following discharge from an Inpatient Admission for the same or similar condition. We do not provide Benefits for health club memberships, exercise equipment, charges from a physical fitness instructor or personal trainer, or any other charges for activities, equipment, or facilities used for developing or maintaining physical fitness, even if ordered by a Physician. This exclusion also applies ASD: We provide coverage for members who are five years of age or under for any assessments, evaluations or tests by a licensed physician or licensed psychologist to diagnose whether an individual has an Autism Spectrum Disorder. Treatment of Autism Spectrum Disorders is covered when it is determined by a licensed physician or licensed No distinction between rehab and hab Maintenance explicitly excluded ASD services covered under Other 22

23 to health spas. No Benefits are provided for treatments such as: massage therapy, paraffin baths, hot packs, whirlpools, or moist/dry heat applications unless in conjunction with an active course of treatment. We do not provide Benefits for maintenance services, treatments or therapy. We do not provide speech therapy benefits for deficiencies resulting from mental retardation and/or dysfunctions that are self-correcting, such as language treatment for young children with natural dysfluency or developmental articulation errors. We do not provide Benefits for vision therapy, including treatment such as vision training, orthoptics, eye training, or eye exercises. psychologist that the treatment is Medically Necessary Health Care, as defined in the Certificate of Coverage. A licensed physician or licensed psychologist may be required to demonstrate ongoing medical necessity for coverage at least annually. ABA is covered for children under 5, as are early intervention services for members ages birth to 36 months of age with an identified developmental disability or delay. 23

24 Maryland 30 visits per condition per contract year for each of PT/OT/SLP For Members from birth to age 19, habilitative services means services, including OT/PT/SLP, orthodontics, oral surgery, otologic and audiological therapy for the treatment of children with congenital and genetic birth defects to enhance the child's ability to function. For Members age 19 and above, habilitative services means habilitative services in parity with rehabilitative services: 30 visits per condition per None Habilitative benefits in the State's EHB benchmark require plans to cover habilitative services benefits for members age 19 and above in parity with benefits covered for rehabilitative services. Habilitative services means services, including occupational therapy, physical therapy, and speech therapy, for the treatment of a child with a congenital or genetic birth defect to enhance the child s ability to function. (Md. Code Ins (a)(3)) (existing statutory definition not pursuant to ACA or specific to EHB) Reasonably good coverage (e.g. distinct, explicit mention of therapies, parity) 24

25 Massachusetts Michigan 60 visits per year of OT/PT (unclear whether the visit limits are distinct for OT/PT and rehab/hab) 30 visits a year apply to all rehab services (potentially combined with chiropractic) contract year for each of PT/OT/SLP See rehab None No limit applies to autism, home health care, and speech/hearing disorders. See definitions None Habilitative Services are defined as health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities. No distinction between rehab and hab Only state where verbatim NAIC definition is listed under hab in CCIIO s materials No explicit mention of therapies covered under rehab Chiropractic visits combined with rehab benefit? The Commissioner has determined that habilitative services encompasses many types of services, including but not limited to applied behavioral analysis (ABA) for the treatment of autism spectrum disorder. ABA is defined by Michigan law as the design, implementation and evaluation of environmental modifications, 25

26 Minnesota (default) Mississippi Covered with no description PT/OT combined 20 annual visit limit; SLP separate 20 annual visit limit Covered with no description See rehab and definitions using behavioral stimuli and consequences, to produce significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior. None None No actual descriptions of Therapy services related to general conditioning of the patient; therapies rendered primarily for job training; pulmonary rehabilitation; speech therapy for learning disabilities and developmental problems; Rehab: Benefits for the coordinated use of medical, social, educational or vocational services, beyond the acute care stage of disease or injury, for the purpose of upgrading the physical functional ability of a patient disabled by disease or injury so that the patient may independently carry out ordinary daily activities. coverage No distinction between rehab and hab Missouri (default) PT/OT/SLP, pulmonary therapy and cardiac rehabilitation. Separate 20 visit limit for PT/OT, Pulmonary Rehab; 36 visit limit for See rehab OT Non Covered Services include: supplies (looms, ceramic tiles, leather, utensils); therapy to improve or restore functions that could be Hab: Covered as defined by Rehabilitation Services. ASD: Benefits include Medically Necessary Covered Services to diagnose and treat Autism Spectrum Disorders when prescribed or ordered for a Member diagnosed with an No distinction between rehab and hab ASD services covered under Other 26

27 Cardiac Rehab. Benefit limits are shared between rehabilitation and habilitation services. expected to improve as the patient resumes normal activities again; general exercises to promote overall fitness and flexibility; therapy to improve motivation; suction therapy for newborns (feeding machines); soft tissue mobilization (visceral manipulation or visceral soft tissue manipulation), augmented soft tissue mobilization, myofascial; adaptions to the home such as rampways, door widening, automobile adaptors, kitchen adaptation and other types of similar equipment. Non-Covered Services for physical medicine and rehabilitation include, but are not limited to: admission to a Hospital mainly for physical therapy; long term rehabilitation in an Inpatient setting. Autism Spectrum Disorder by a licensed Physician or licensed Psychologist. Covered Services include the following: Diagnosis of Autism Spectrum Disorders Medically Necessary assessments, evaluations, or tests in order to diagnose whether an individual has an Autism Spectrum Disorder; Habilitative or rehabilitative care Professional, counseling, and guidance services and treatment programs, including Applied Behavior Analysis from a licensed Autism service Provider or Line Therapist under the direct supervision of a licensed Behavioral Analyst, which are necessary to develop the functioning of the Member; Psychiatric care Direct or consultative services provided by a licensed Psychiatrist; Psychological care Direct or consultative services provided by a licensed Psychologist; Therapeutic care Services provided by 27

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